Foster kids and medication

Sunshine Girl has another post on the over-medication of foster kids.

Whenever I read them I go through the same set of thoughts:

• Sometimes these drugs are lifesavers, literally. I don't think that Sunshine Girl would dispute this. She is concerned about over-medication, not genuinely needed medication.
• Given their personal and often family histories, it should not surprise us that foster kids are more likely to be on medication than the general public.
• Even so, there is far too much medication of foster kids.
• What bothers me even more is that I see little to no planning for how the kids will manage post-emancipation. Too often the kids do not know either how they will manage without the meds or manage to get them once they are on their own.

I'm going to share something that I don't think I have put on the public blog before. I'm a little nervous.

In my husband's side of the family there is some pretty dramatic examples of both depression and bipolar disorder. Brian has been taking a medication that is not recommended for children for more than two years. I'm not going to share everything about Brian's odyssey, but I will share two things. First, the child psychiatrist took more than a year to get his medication and dosage right. Brian spent months on sub-therapeutic dosages while we watched to see if he was going to have a bad reaction to them. He did have bad reactions to ADD meds.* It was done slowly and carefully. He is on the meds he is because research into what has worked for his relatives and is own responses demonstrate that that is what is best for him.

Second, if I could cry in gratitude for the existence of these drugs. They gave me my son back. I have no doubt that Brian's issues are biological, genetic, and thank G-d they are treatable.

The foster boys have had a different history. One of them suffers, I believe, from a low-grade, chronic, possibly biological depression. He was on anti-depressants for about six months during which time I thought he felt better and was more successful in achieving his goals than when he was not. He chose to go off them. One of them wanted anti-depressants to make him better, but they didn't. The entire time he was with me he kept demanding that his doctor try him on a different drug. None of them did what he wanted them to do. Another refused to take them, which I supported. It never seemed to me that he needed them.

They were all offered anti-depressants.

It was not like it was with Brian. Partly it couldn't be. There could be no detailed family history; no discreet phone call to Uncle What'sHisFace to ask, "Can you tell me which drugs you took and which ones helped?" But in part it could have been. Of course they were 15-17 and not 10, but they did not spend months at sub-therapeutic doses while people watched for negative reactions.

When Mandy brings girls over for respite I no longer ask if they are on medications. I ask, "Where are the instructions for her meds?" I am up to N on my alphabetized list of respite kids. One of those kids was not medicated.

My experience confirms that medications are given too quickly and with too little oversight. Once they are on the medication, no one seems to ask whether they need to be on them indefinitely.

As I said before, I am especially bothered by the minimal (not non-existence) planning for treatment post-emancipation. That is a problem that goes beyond foster care though. The sad truth is that too many people in the US don't have adequate health care and foster kids tend to become members of that group.

So this so far has just been rambling. Usually I try to share experience and not give advice, but I am going to offer advice here:

1. If your foster child seems to you to be over medicated DO NOT DISCONTINUE the drugs on your own. Even if the drug they are on is not good for them, a sudden withdrawal can be worse.
2. Talk to the prescribing doctor about your concerns. Assure them you are willing to watch them closely. Tell them you want to wean them off whatever meds you can.
3. If you have older kids, let them be part of the decision.
4. As the children get close to emancipation, have serious conversations with the social worker, the doctor, and the youth about what they need and how they can afford to pay for it.
5. Consider not reminding kids to take their meds the last year they are with you. If they are going to have trouble remembering it is better for them to experience the consequences of that decision while they are still at home.

Okay, that's it. Not my most exciting piece of writing ever, just some basic thoughts about the medication of children.

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*Brian has a friend who takes an ADD med which has helped him greatly. Last summer this boy started acting out at my house and I told his mother that I did not know what was going on. He had not done these sorts of things for years. She sighed and said that her son had wanted to try not taking his meds for the summer, but they had decided he needed them. When he is on them he does not seem "drugged" but he does have impulse control.